The prevalence of non-alcoholic fatty liver disease (NAFLD) in polycystic ovary syndrome (PCOS) has not been previously described. As insulin resistance has been implicated in the pathogenesis of both NAFLD and PCOS, we hypothesized that NAFLD would be common in PCOS. We performed a retrospective study of 88 consecutive pre-menopausal subjects (median age 31.4 years, interquartile range 24.1-36.9 years; median BMI 26.9 kg/m2, interquartile range 22.0-36.2 kg/m2) with PCOS from a single private endocrinology practice in New York City. Patients denied heavy alcohol(Drug information on alcohol) use and known liver disease; all met the 1990 NIH criteria for PCOS, namely menstrual dysfunction and hyperandrogenism with the exclusion of other causes. The severity of hepatic steatosis by ultrasound (US) was graded as none, mild, moderate, or severe by radiological criteria. Patients were grouped by BMI, where lean denoted BMI<25 kg/m2, overweight denoted BMI≥25 but <30 kg/m2, and obese denoted BMI≥30 kg/m2. Treatment with metformin(Drug information on metformin) was noted in 46, oral contraceptives in 32, neither in 32, and both in 22 subjects; 3 had type 2 diabetes. Forty eight (55%) had steatosis by US criteria. Higher BMI group was associated with increasing grade of steatosis, stratifying on treatment with oral contraceptive, metformin, neither, or both (Cochran-Mantel-Haenszel test, p=0.0005). In addition, the presence of steatosis was associated with a greater median BMI (31.3 vs. 24.3 kg/m2, p=0.005) and pre-metformin HOMA-IR (3.53 vs. 1.50 mmol mIU/L2, p=0.033) and lower median fasting HDL cholesterol (54 vs. 64 mg/dL, p=0.003) by the Mann-Whitney U test. There were no significant differences in median age, fasting glucose, fasting insulin, total cholesterol, LDL cholesterol, or triglycerides in those with and without steatosis with a=0.05. Of note, only 7 of the 48 subjects with steatosis (15%) had abnormal liver chemistries. We conclude that hepatic steatosis is common in women with PCOS and even in lean patients. High BMI and insulin resistance appear to be important factors. As non-alcoholic steatohepatitis is a risk factor for the development of cirrhosis and hepatocellular carcinoma, high prevalence of hepatic steatosis in this population of otherwise healthy young women with mostly normal liver chemistries is a concern.
Table. Prevalence and severity of steatosis by BMI group.
| BMI group | N | None % | Mild % | Moderate % | Severe % | Overall Prevalence % |
| Lean | 38 | 61 | 26 | 11 | 3 | 39 |
| Overweight | 13 | 46 | 23 | 15 | 15 | 54 |
| Obese | 37 | 30 | 22 | 14 | 35 | 70 |
| Total | 88 | 45 | 24 | 13 | 18 | 55 |
B mode and 3D Ultrasound images of a fetal abdomen (35wks) revealing gallbladder calculi
This case study shows a 26 week gestation with a cystic mass close to the sacrum.
CC is a 31 year old primigravida who was referred for ultrasound at a community hospital due to suspected cardiac anomalies noted on a screening sonogram at her doctor's office. Due to concern about a probable cardiac abnormality an amniocentesis was performed at the local hospital.
Single umbilical artery color doppler, transverse scan of urinary bladder shows single umbilical artery (left), transverse section of umbilical cord showing only two vessels: one vein and one artery (right).
Normal 35 week pregnancy